Responsiveness to the chlorhexidine epidural tragedy: a mental block?

Paralysis following an epidural anaesthetic is a rare event. The mechanism usually involves accidental injection of skin antiseptic instead of local anaesthetic. Two recent cases, one involving paralysis, the other a "near-miss", are described. The first case resulted in an extensive root cause analysis and an admission of liability by the hospital. The response of the anaesthetic community and the New South Wales Department of Health was swift but failed to produce uniform protocols across the region. Furthermore, the requirement of medical staff to double check medications with a second person before their administration was not addressed. Abandoning a more effective but neurotoxic antiseptic solution in favour of a solution with weaker antiseptic properties, as had previously occurred in one Sydney hospital, could incur higher risks of epidural infection. Defensive medical practice can lead to unwanted negative consequences.     

Policy,Practicalities, and PACE s. 24: The Subsuming of the Necessity Criteria in Arrest Decision Making by Frontline Police Officers

PACE, as amended by the Serious Organised Crime and Police Act 2005, establishes a complex framework of factors that police officers must consider during arrest decision making. Officers must possess a reason to arrest, it must be necessary to arrest for that reason, and they must give at least a ‘cursory consideration’ to alternatives. Based on a four‐year ethnographic study of frontline officers from two forces in Northern England, we argue that the 2005 reforms have not achieved their aims. The new regime tasks officers with undertaking a complex legal assessment prior to arrest, but officers are often confused about the necessity criteria which, moreover, is typically a minor consideration in contrast to demanding practical and policy pressures. This means that unlawful and non‐human‐rights‐compliant arrests continue to be regularly made and, equally significantly, many suspects are escaping the criminal justice system because officers are not considering arrest alternatives.     

Reviewer’s Comments to “The Measurement of Legitimacy: a Rush to Judgment?”

Asian Journal of Criminology -     

Persistence of spermatozoa and prostatic acid phosphatase in specimens from deceased individuals during varied postmortem intervals

The survival of spermatozoa and the persistence of prostatic acid phosphatase has been an area of interest for investigators of sexual assault. However, not much documentation exists concerning the examination of a deceased individual with regard to the postmortem interval and presence of such evidence. The authors reviewed cases referred to the medical examiner's office during a 10-year period. During this time, 199 cases were both autopsied and examined for sexual assault. In particular, these examinations included procurement of swabs for Papanicolaou staining of smears and for quantitation of prostatic acid phosphatase. Most of the victims were female, although a few were male. In the majority of cases, the swabs for smears and prostatic acid phosphatase were taken from oral, vaginal, and anorectal areas in females and oral and anorectal areas in males. The smears all were stained with the routine Papanicolaou stain, and intact spermatozoa and spermatozoan heads were sought. The prostatic acid phosphatase was analyzed by the microparticle enzyme immunoassay method and reported as ng/ml. A level of greater than 100 ng/ml was considered positive. The cases were analyzed with respect to postmortem interval; presence or absence of intact spermatozoa or spermatozoan heads; presence of an elevated prostatic acid phosphatase; body location of the specimen; the time of year; location of the victim; and physical injury (anogenital) of sexual assault. The authors hope that by examining the laboratory evidence of sexual assault, a correlation can be drawn between the presence or absence of such evidence and the aforementioned variables.     

An unusual case of anaphylaxis. Mold in pancake mix

Anaphylactic reactions involve contact with an antigen that evokes an immune reaction that is harmful. This type of reaction is a rapidly developing immunologic reaction termed a type I hypersensitivity reaction. The antigen complexes with an IgE antibody that is bound to mast cells and basophils in a previously sensitized individual. Upon re-exposure, vasoactive and spasmogenic substances are released that act on vessels and smooth muscle. The reaction can be local or systemic and may be fatal. The authors report the death of a 19-year-old white male who had a history of "multiple allergies," including pets, molds, and penicillin. One morning, he and his friends made pancakes with a packaged mix that had been opened and in the cabinet for approximately 2 years. The friends stopped eating the pancakes because they said that they tasted like "rubbing alcohol." The decedent continued to eat the pancakes and suddenly became short of breath. He was taken to a nearby clinic, where he became unresponsive and died. At autopsy, laryngeal edema and hyperinflated lungs with mucous plugging were identified. Microscopically, edema and numerous degranulating mast cells were identified in the larynx. The smaller airways contained mucus, and findings of chronic asthma were noted. Serum tryptase was elevated at 14.0 ng/ml. The pancake mix was analyzed and found to contain a total mold count of 700/g of mix as follows: Penicillium, Fusarium, Mucor, and Aspergillus. Witness statements indicate that the decedent ate two pancakes; thus he consumed an approximate mold count of 21,000. The decedent had a history of allergies to molds and penicillin, and thus was allergic to the molds in the pancake mix. The authors present this unusual case of anaphylaxis and a review of the literature.     

Elderly suicide: a 10-year retrospective study

The suicide rate in the 65-year and older age group has been increasing since 1980. The elderly attempt suicide less often than younger people but are successful more often. The authors retrospectively reviewed all cases referred to the Forensic Pathology Section of the Medical Examiners' Office at the Medical University of South Carolina (Charleston, SC) from January 1988 through December 1997. The cases of suicide in victims 65 years and older totaled 78, accounting for 11.5% of all suicides reviewed. Of these 78 cases, 41% were autopsied and 59% were externally examined. All of the cases were initially analyzed as to age, race, sex, and method of suicide. Files also were reviewed to determine time of year of the suicide, toxicology results, psychiatric history, social history, medical history, and whether a suicide note was left. The ages of these suicide victims ranged from 65 to 94 years; men comprised 85% of the victims, and whites, 94%. The male-to-female and white-to-black ratios were 6:1 and 15: 1, respectively. The average age of the victim was 73 years. Gunshot wound was the most common method of suicide, accounting for 80.7% of the cases. Other methods included overdose (6.4%), hanging (3.8%), fall from height (2.6%), incised wounds (2.6%), drowning (2.6%), and carbon monoxide poisoning (1.3%).     

The association between multiple drug misuse and crime

Research that has investigated the association between specific drug types and crime has tended to focus on the specific drug type in isolation from other drugs. The main problem with this is that it cannot be assumed that the association between specific drug use and crime will be the same regardless of the additional drugs consumed. The research aimed to investigate whether there was a correlation between number and type of drugs used and involvement in crime. The analysis of multiple drug use was based on data collected as part of the New English and Welsh Arrestee Drug Abuse Monitoring program in the United Kingdom. The results showed that both the number of drug types consumed and the particular drug type combinations used explained offending rate. The research concluded that the investigation of links between multiple drug use and crime might help inform antidrugs strategies and treatment services.     

Reducing and preventing organised crime: An evidence-based critique

Theory and practice in crime prevention and crime reduction have developed and changed significantly, but attention has been focused largely upon conventional forms of crime (especially street crime) and upon situational approaches to their reduction. Drawing on research with a variety of relevant organisations across Europe, this article explores the possibilities of developing more effective crime reduction strategies in respect of organized crime, an area in which (despite important exceptions, particularly in relation to financial regulation), law enforcement rather than prevention has continued to dominate the thinking and the practical responses of the police and other relevant agencies. It illustrates the difficulties of evaluating prevention in the many areas in which data quality on crime levels and their organisation are poor, but also gives examples (mainly financial crime) where private sector data quality are good enough to demonstrate effectiveness. It differentiates impact on crime from impact on the organisation of crime, and between market crimes involving voluntary vice and predatory crimes involving direct harm to victims, concluding that current performance indicators for enforcement agencies may need substantial revision if the focus shifts to organised crime reduction.     

Application of the HIPAA privacy rule to employer benefit plans and a compliance theory of statutory interpretation

The application of the federal privacy regulations promulgated pursuantto the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to employer benefit plans is arguably the most conceptually difficult area of a complex law. A purely textual reading of the Rule, when applied to employer plans, results in varying interpretations on some significant issues and puzzling results on others. This Article offers a practical approach for interpreting the rule when clear-cut answers are not provided by the text and DHHS guidance is nonexistent or unclear. In addition, this approach can be applied to the interpretation of other statutes and regulations.